Small note but this seems false: "directly increasing wellbeing without ethical tradeoffs (e.g., no “meat-eater problem”)"
If mental health interventions increase the number of DALYs in the world, then they definitely run into the meat eater problem (where each year of human life will cause X years of animal suffering).
Not making any particular comment on the meat eater problem here, just commenting to point out that you can't avoid trade-offs this easily :)
Thanks for the post. The top 2 interventions are more in the area of global health and development (GHD) than in that of mental health, considering they mostly increase income (Pure Earth) and improve physical health (Taimaka)?
I don't think there is a claim that they are mental health interventions - the blue hue only denotes they were evaluated by HLI, probably for the sake of comparison with other interventions. For example, Fortify Health is also in there and I don't think the authors are under the illusion that it's a mental health intervention
Hi Jamie. I agree.
The Happier Lives Institute’s investigations into intervention cost-effectiveness find that some mental health interventions are over 5x more effective than GiveDirectly’s cash transfers
Nitpick. I do not think the above is exactly supported by the graph with the cost-effectiveness comparison. According to this, only Friendship Bench (48.5 WELLBY/k$) is over 5 times more cost-effective than GiveDirectly, which corresponds to having a cost-effectiveness over 45.6 WELLBY/k$ (= (1 + 5)*7.6/10^3). There are 2 charities, Friendship Bench and StrongMinds (40.4 WELLBY/k$), which are more than 5 times as cost-effective as GiveDirectly, which corresponds to having a cost-effectiveness over 38.0 WELLBY/k$ (= 5*7.6/10^3), but they both deliver the same type of mental health intervention ("Task-shifted group
psychotherapy").
Mental health IS health. Period.
Integrating mental health with physical health understanding & treatment would really transform outcomes. I started my career in mental health intervention research and it's hard to see so many years later the same efforts having to be made. The org I first worked with has a campaign on now Mental health is health, making the case it's debilitating nonsense that some illnesses are treated like illnesses while others are treated with judgement, neglect, silence.
I appreciate stand-alone, MH illness specific action as it's so neglected and also wonder if whole-health integration as a goal for effective interventions would raise all boats, so to speak?
This is really great to see you are doing the work within EA. We could add to this that depression is now the #1 global cause of ill health & disability, more than injuries or any disease it takes people out of life and job functionality.
And it got to number one because it is rapidly increasing so much that now it’s on track within some years to become the #1 cause of death of all health issues*.
I think it’s worth saying another way. Depression disables people so they can’t go to work or take care of their family and the WHO says this disabler is the biggest one in the whole world. Depression puts people on the path to death and on the way to death it disables you first. This crept up on us and we didn’t realize it as altruists.
I feel it’s like when some teens get killed at a dangerous intersection and finally the town puts up a stop sign, and we all comment “Why did we have to wait for these kids to get killed before we acted”?
Mental Health is clearly a coming tragedy that’s been neglected more than almost any…and we have very clear tractable solutions that just haven’t been used. It’s the perfect ITN framework vector towards action. EA should get out on the front end of it like we have other cause areas. The team that wrote this post are the main ones in EA that recognize this and I hope we’ll all join them.
*note: raw google searches will find some confusion because blindness is also sometimes called the number one disability but they are different. Blindness is a functional issue you can be born with. Depression is the biggest ill health leading to disability.
Context: Effective Mental Health is a new group working to improve the field of global mental health along EA principles (and we're running another round of our Global Mental Health Fellowship, see info / apply here!).
Here, we outline the quick & basic case for why field-building work in effective global mental health seems especially cost-effective.
Mental, neurological, and substance-use disorders account for 12% of the global burden of disease when measured in DALYs, yet mental healthcare accounted for just 2.4% of global healthcare spending in 2016. Treatment gaps are massive; most people with mental illness do not receive treatment (only 22% of people with mental illness in high-income countries, and as little as 4% of those in low-income countries, receive treatment).
Promising mental health interventions are cost-effective in both low- and high-income countries. The Happier Lives Institute’s investigations into intervention cost-effectiveness find that some mental health interventions are over 5x more effective than GiveDirectly’s cash transfers:
Many proven, evidence-based interventions already exist, but are bottlenecked by lack of prioritization, funding, and implementation.
We also expect that there will also be important “paradigm shifts” and approaches (e.g. new substance based treatments, AI assisted therapies, policy shifts, training lay therapists…) that could unlock radically improved quality and scalability in mental health interventions, yet much of the mental health world currently does not focus on outcome effectiveness nor innovation.
AIM (Charity Entrepreneurship) notes that since many foundations and funders are focused on a particular geography or cause area (e.g. mental health), “even if mental health interventions turn out not to be as cost-effective as the best global health program, there is still a substantial opportunity for impact”, since these interventions may have access to donors who wouldn’t otherwise fund traditional EA cause areas.
In other words, expanding work in effective mental health need not displace other effective programs, resulting in strong marginal and counterfactual value given existing funding ecosystems.
Improving mental health is ethically robust across moral systems, directly increasing wellbeing without ethical tradeoffs (e.g., no “meat-eater problem”). MH interventions target what matters most: how happy sentient beings actually feel, which may be robust both in the near-term and across many potential long-term scenarios. There may be important positive externalities to improving the effectiveness of global mental health as a cause area; e.g. improved measures and targeting of subjective wellbeing could help us set priorities or align AGI to genuinely positive human values. Some of the worst forms of human suffering stems from mental health problems, so understanding how to assess and avoid the worst subjective mental states may robustly increase our ability to reduce extreme suffering.
In 2020, AIM (Charity Entrepreneurship) noted that there is growing interest in the mental health space from the Effective Altruism community, with 4% of EAs ranking MH as their top cause area in 2018. However, as in previous years, the recent 2024 EA Survey found that mental health is consistently the lowest-ranked EA cause area overall across EA regions (participants are asked to rank cause areas on a 1-5 scale, where 1 = “I do not think any resources should be devoted to this cause”, and 5 = “This cause should be the top priority”).
Despite its vast scale and neglect, mental health remains an under-invested frontier for high-impact work. Proven, low-cost interventions already exist, yet they remain bottlenecked by insufficient funding, prioritization, and innovation. Moreover, mental health offers unusually strong moral and epistemic robustness: nearly all ethical frameworks (and many potential future scenarios) robustly value reducing suffering and increasing happiness, which are efficiently targeted by mental health interventions and meta-work. Better understanding and alleviating mental suffering may also provide broader benefits, from improving global wellbeing metrics to informing the genuine alignment of ASI. Work in this cause area could run on new funding streams that do not compete with traditional EA priorities. In short, improving the field of effective global mental health represents a neglected, tractable, and deeply humane opportunity to make the world better, with the potential for extraordinary returns. Expanding EA interest in mental health direct & meta-work seems potentially quite valuable.
Nice, this sounds excellent! I've been thinking about the implications of AI for mental health lately so was excited to see you've got an 'AI Mental Health Initiative' working group. Are you able to share any more about what that entails and how you're thinking about that at this stage? From my brief searches AI's potential for developing more effective medications, AI-boosted therapy techniques, etc. seems fairly under-discussed.